NURS 307 - FINAL REVIEW

NURS 307 - FINAL REVIEW. FINAL REVIEW (40:39 on BB Collab) 1. Treatment for Pulmonary Atresia • Prostagladin E to keep PDA • Treat symptoms of CHF • Surgery 2. Where to give intramuscular injection Infants = vastus lateralis Peds = deltoid 3. Anatomy and physiology of infant’s heart 4. Childhood patent ductus arteriosus... What to find on assessment? • dyspnea , tachycardia • Full, bounding pulses • Hypotension • “Machine” murmur 5. Know what pertussis (Whooping Cough) is Patho: • Pertussis is primarily a toxin-mediated disease. The bacteria attach to the cilia of the respiratory epithelial cells, produce toxins that paralyze the cilia, and cause inflammation of the respiratory tract, which interferes with the clearing of pulmonary secretions. s/s: • Runny nose • Low-grade fever (generally minimal throughout the course of the disease) • Mild, occasional cough • Apnea – a pause in breathing (in babies) Vaccine for it is → DTap 6. Kawasaki disease Know what they are likely to develop While the majority of heart disease in children is congenital (present at birth), it is possible for kids to develop heart disease later in childhood. Kawasaki disease is the leading cause of acquired heart disease in kids. Acute: • Irritability • high fever lasting 5 or more days • red throat Subacute: • afebrile, • cracking lips and fissures, • desquamation of skin on tips of toes and fingers, 7. Know how to treat Rheumatic fever • Antibiotics • Aspirin • Prophylactic antibiotics for invasive procedure and dental work 8. Know what successive vaccinations are releasing antibody antigen response ?? 9. Know the evaluation of the infants that are septic Infants under 2 months → Any fever in an infant under 1-2 months needs to be evaluated for neonatal sepsis • At risk for neonatal sepsis • Workup → LP , Blood & urine cultures, IV antibiotics ASAP & monitoring 10. Atrial septic defect.. what kind of shunt is it? LEFT to RIGHT shunting of blood 11. know different disorders that fall under the umbrella of cyanotic disease • Pulmonary Atresia • Tricuspid Atresia • Tetralogy of Fallot 12. therapeutic regimen for patient with heart failure will be • Maintain fluid and electrolyte balance • Decrease workload of the heart • Provide adequate nutrition • Increase tissue oxygenation -- not sure? maybe? Meds: diuretics, ACE inhibitors 13. client education for sickle cell disease • Often at an early age this child becomes opioid tolerant • Seizure precaution 14. parenteral education for patient with hemophilia (Things they need to avoid) AVOID BLEEDING EPISODES 15. Foods they need to take for iron deficiency anemia Foods high in iron such as • Shellfish • Spinach • Live and other organ meats • Legumes (beans, lentils, chickpeas, peas, soybeans) • Red meat • Pumpkin seeds 16. Long term complications of thalassemia major Severe anemia? 17. If child has ITP and given steroids what do you need to monitor for? • PLATELETS • Monitor for Infection and hyperglycemia 18. Aplastic Anemia know pathophysiology Patho: Failure of bone marrow to produce blood cells resulting in pancytopenia Develops after treatment with radiation, medications, infections or congenital in nature. 19. Know what STAGE 2 WILMS TUMOR MEANS Patho: Intrarenal tumor that grows rapidly (doubling in size approx 11-13 days Manifestations: • Firm, lobated mass on one side or midline of abdomen • If symptomatic: HTN, abdominal pain and or hematuria Management: • Nephrectomy of affected tumor • Chemo and/or radiation • Don’t palpate mass aggressively Stage II: (graph in textbook) -tumor extends beyond the kidney and is completely excised -regional extension of the tumor is presented -vessels outside the kidney are infiltrated or contain tumor thrombus 20. Lymphatic Leukemia Patho: Stem cells in the bone marrow produce immature WBCs that do not function normally and are produced at a rapid rate that replaces the normal functioning cells leaving the body at an increased risk for infection. • Acute lymphatic leukemia- affects lymphocytes predominantly Manifestation: • Petechiae • Ecchymosis • Abnormal bleeding • Fever • Splenomegaly Diagnosis: • initially made by abnormal CBC (anemia, thrombocytopenia and/or neutropenia • Confirmed by bone marrow aspiration 21. Comfort Care 22. know what to do diagnosis with terminal illness... what type of treatments are available for that scenario 23. know what to do for immunodeficiency syndrome for HIV Patho: HIV destroys the T cells in the body leaving the immune system weakened and allows for opportunistics infections Management: • Preventions of transmission • Prevent opportunistic infections • 24. Child with AIDS.. as a nurse you would use to ENCOURAGE EFFECTIVE LUNG EXPANSION. (PROF WILL CHANGE QUESTION) 25. know the activities that children with juvenile rheumatoid arthritis can do.. and most appropriate thing for them to do They need extra time completing ADLs 26. Know what is caused by histamine release. KNOW (ALLERGIC REACTION) Patho: Antigen-antibody reaction to an allergen Can manigest as anaphylaxis, atopic dermatitis, contact dermatitis, serum sickness Allergen binds to antibodies on mast cells → Histamine is released from the mast cell → an allergic reaction ensues 27. FIRST priority for anaphylatic shock AIRWAAAAAY! ABC’S ALSO, Avoidance of allergen 28. Know what to do for anaphylactic shock • Avoidance of allergen • ABC’s • Epinephrine, IV, or IM 29. Pathophysiology for anaphylactic reactions Patho: Anaphylaxis is a severe, systemic hypersensitivity reaction that is rapid in onset and characterized by life-threatening airway, breathing, and/or circulatory problems, and that is usually associated with skin and mucosal changes. 30. Know histamine response (STUDY PICTURE ON SLIDE) Sensitization: Initial exposure to allergen Allergen (ie: pollen, grain) enters into the bloodstream → B cells differentiate into plasma cells and make antibodies → antibodies attach to mast cells Allergic Reaction: Secondary exposure to same allergen Allergen binds to antibodies on mast cells → Histamine is released from the mast cell → an allergic reaction ensues 31. Brain Tumor (SELECT ALL THAT APPLY) 4 things on brain tumor (4 SYMPTOMS) Manifestations: • Behavioral and nervous system changes • Increased ICP (rapid or slowly) o Headache o Nausea o Vomiting o Abnormal gait o Dizziness o Vision changes o Fatigue +mental status changes or educational problems Treatment: • Surgery • Chemotherapy and/or radiation 32. Non-Hodgkins lymphoma that nurse is at high risk for kidney or renal disorders tenks 8===D~~ SMH *He said to focus on the difference between these two. Hodgkin NON-Hodgkin Patho: starts in a single lymph node or chain • Large cell with multiple nuclei Patho: T-cell abnormalities that cause immature, malignant and diffuse T-cells • Often occurs in children with congenital or acquired immunodeficiency, autoimmune diseases. s/s • Nontender, firm lymphadenopathy • May cause resp. Symptoms if pressure is placed on trachea or bronchi • If progressed → fever, night sweats, and weight loss s/s • Fever • Weight loss • Enlarged or nodular lymph nodes may or may not be present o May cause resp. Compromise if trachea/bronchi has pressure • Pain and swelling in lymph nodes • Swelling of face • Enlargement of lymph nodes: o Neck o Armpits o Groin • RESP: o SOB o Chest pain o Difficulty breathing o Coughs • Abdominal pain, distention, bloating and constipation • Loss of appetite, diarrhea, weight loss Management • Chemotherapy and/or radiation • High survival rate Management • Chemotherapy and/or radiation • Hematopoietic stem cell transplant for recurrent disease 33. Diagnosis of acute lymphatic leukemia know diagnosis for this one (PATHO) PATHO: • Stem cells in the bone marrow produce immature WBCs that do not function normally and are produced at a rapid rate that replaces the normal functioning cells leaving the body at an increased risk for infection • ***ALL (acute lymphocytic leukemia) – affects lymphocytes predominantly*** DX: • Initially made by abnormal CBC (anemia, thrombocytopenia and/or neutropenia) • Confirmed by bone marrow aspiration 34. Hodgkins disease patient with hodgkins.. know expected findings • Nontender, firm lymphadenopathy • Respiratory difficulty • Fever • Night sweats, weight loss 35. neuroblastoma study manifestations.. they will have an ELEVATION IN WHAT?????? Tumor markers: Homovanillic acid (HVA) and vanillylmandelic acid (VMA) are by- products of adrenal hormones are usually elevated in the urine and blood -Elevation in dopamine, ferritin, NSE, LDH, and GD2 Manifestations: • Dependent on the location of the mass, but problems are caused by pressure onto organs • Weight loss • Abdominal distension • Irritability, fatigue, fever Elevation in whaaaaat??? 36. Sickle Cell Disease know what it does to the tissue how it causes pain • Obstruct capillary blood flow → tissue ischemia/hypoxia → organ tissues become damaged and impaired function • pain results from avascular necrosis of the bone marrow 37. Lupas.. Know the highest priority nursing diagnosis PAIN? Body Image? Patho: Autoantibodies are produced and immune complexed form and are deporisted into connective tissue, triggering and inflammatory response which overtime damages the connective tissue. • Can affect all organs, but small blood vessels, glomeruli, joings, spleen and heart valves most common Manifestation: • Classic sign: butterfly rash • Fever • Fatigue • Arthritis • Nephritis (leading cause of mortality in children) 38. know if adolescent is hospitalized what are most concerned about? • Body image 39. know what area of PRE-school age, how they view illness • They may view illness as punishment 40. KNOW the N-PASS • Neonatal Pain, Agitation and Sedation Scale • Age range: 23 weeks to 100 days old • Use: Uses behavioral and physiological parameters to assess pain and sedation 41. Know peak occurrence of POISONING in children Peak occurrence of poisoning → 1 - 4 years old*** 42. piaget.. when formal operational thought begins • Formal operation though begins at age 12 to adulthood • Demonstrates abstract thinking, including logic, deductive reasoning, comparison, and classification. (ppt) 43. ERIKSON’S STAGES 1. Trust vs Mistrust o 0-1 yr o Achieve a sense of trust in caregiver and environment 2. Autonomy vs Shame and Doubt o 1-3 yr o Achieve control over bodily secretions ▪ Potty training is the major milestone of the age o Learning to decide for themselves what to do for fun o Testing limits o If constantly being yelled at and not encouraged will develop shame and doubt 3. Initiative vs Guilt o 3-6 yr o Interested in new activities o Wants to help parents and be more involved o Criticism leads to guild and lack of purpose 4. Industry vs inferiority o 6- 12 yr (SCHOOL AGE) o Takes pride in accomplishments o New interests o Sports, clubs, etc. 5. Identity vs role confusion o 12-18 yr (ADOLESCENT) o Becoming an individual with a more defined sense of identity 44. know what an extended family is Relatives (grandparents, aunts, uncles, etc.) 45. Read up on family history 46. data points on developmental scale 47. down syndrome (SELECT ALL THAT APPLY) 4 answers that are right.. know the characteristics Manifestations of DS: 1. flattened face 2. small head 3. short neck 4. protruding large tongue 5. upward slanting eyes (palpebral fissures) 48. know what pneumothorax is • Pneumothorax = air enters the pleural space • (from previous quiz) If there’s total ABSENT breath sounds upon auscultation→ pneumothorax 49. cystic fibrosis effects? -secretions become thickened, lungs clogged with mucus -pancreas stops producing sufficient insulin → DM -s/sx: salty skin, meconium ileus, failure to thrive, resp. Infections, fecal impaction or intussusception -sweat chloride test by pilocarpine iontophoresis 50. asthma • inflammation , mucus production, swelling of airway mucosa • Tiggers: exercise, allergens, changes in weather, smoke, stress, etc. • S/S: Sudden SOB, cough, wheezing o Can progress from resp. Distress → resp. failure! • Management → SABA 51. SIDS (Sudden Infant Death Syndrome) • Occurs mostly between ages of 2-4 months • Parent education o Safe to Sleep o Avoid loose bedding, toys, pillows o Discourage co-sleeping o Use of pacifier recommended for nap and bedtime o Smoking increases risk 52. otitis media • Acute Otitis Media (AOM) = Infection of the middle ear • Otitis media with effusion (OME) = fluid behind tympanic membrane (NO infection) o Signs and Symptoms ▪ Crying, pulling at the ear, recent URI or bacterial infection, fever, lethargy, ear pain, erythematous TM, purulent drainage behind TM ▪ Late signs: purulent drainage in ear canal • Pediatric eustachian tubes are SHORTER and more horizontal leads to increase incidence of AOM & OME 53. Epiglottitis • Life threatening condition, medical emergency A → airway inflammation → obstruction I → Increased pulse R →Restlessness A → Retractions I → Anxiety Increased D→ Drooling 54. Fracture femur to heal= 4 weeks 55. Burn ← and how to describe a burn (superficial, partial full thickness etc) 1st degree (superficial) = pain & reddening of the skin 2nd degree (partial thickness) = pain, redness, swelling, blistering, edema 3rd degree (full THICkness) ← affecting deeper tissues (white or blackened, charred skin) yuucck 56. Marfaan syndrome and how to diagnosis by bodily features • Disease of connective tissue leading to cardiac, skeletal, ocular and respiratory problems Eye problems, long arms and fingers, Abnormal chest, heart and lung problems, short torso 57. Difference strategies to promote growth and development infant development of developmental dysplasia of hip (DDH) -engage the child in activities that stimulate upper extremities and all 5 senses -provide stimulation toys such as stacking blocks, soft balls, musical toys -position toys within reach and interact with child 58. Know the difference with children with DARK SKIN CHILDREN (SELECT ALL THAT APPLY) there will be 3 right answers • Cyanosis- Ashen gray lips and tongue • Pallor- Ashen gray appearance in black skin • Pallor- More yellowish brown color in brown skin • Erythema- Much more difficult to assess; rely on palpation for warth or edema • Ecchymosis- Very difficult to see unless in mouth or conjunctiva • Petechiae-Usually invisible except in oral mucosa, conjunctiva of eyelids and conjunctiva covering eyeball • Jaundice- Most reliably assessed in sclerae, hard palate, palms, and soles 59. Bucks traction-legs are in extended position 60. Russels traction- legs are extended knees flexed 61. Bryants traction- hips are flexed legs both legs 62. Fractured epiphyseal plate what happens? 63. DO NOT TAKE BLOOD PRESSURE WHERE SHUNT IS PLACES... use a different extremity to prevent rupture ← that is correct 64. know clinical manifestations if increased intracranial pressure • HA, N/V, vertigo • Unreactive pupils or fixed and dilated • Sun setting of eyes • Bulging fontanels, widening sutures • High pitched cry • Cushing’s triad: high BP, bradycardia, irregular respirations 65. Seizure disorders are going to have COGNITIVE DELAYS 66. Know how to explain to families what we have to do with patients with ICP what we do in the hospital.. how to respond to family requests... -keep child calm with a quiet and dark environment 67. Hypercalcemia “Which of the following statements are true regarding hypercalcemia?..... WHAT DO YOU GIVE AS A TREATMENT? • 2.7 mmol/L • Caused by increased intake or absorption (example: infant fed too much chicken liver or too much vitamin A/D) • Infants with low birth weight can develop hypercalcemia d/t low phosphorus intake Tx: increase fluids, Lasix, phosphate, glucocorticoids 68. Know how they get HYPOnatremia • most common imbalance in children • Too much water intake,excessive swallowing, forced water intake can’t excrete it • Diarrhea, vomiting with replacement of water only 69. children with glumolular nephritis.. know what typical presentation is -edema - flank pain - irritability - tea colored urine - acute hypertension - may have oliguria Management: Bed rest, diuretics, sodium restriction Dx: elevated ASO d/t past infection of strept 70. Expected urine output of an infant--- 1-2 ml per hour 71. Hemodialysis and patient gets dizzy.. what do you do first? • Stop or slow infusion ?? • Make sure theyre sitting down? Prevent fall? 72. Know the shunt care (post op care) peritoneal shunt.. WHAT DO YOU GIVE? 73. priority interventions Post care for SHUNT patients (2 questions) 74. basic functions of the urinary system • Excretes waste and maintains acid-base, fluid and electrolyte balance 75. Anterior pituitary gland.. how would it present if it Is hypofunction 76. management of type 1 diabetes -remember 3 P’s and monitor for DKA (high BS, Kussmaul’s) 1. Polyuria 2. Polydipsia 3. Polyphagia 77. management or scener of type 1 diabetes BEDWETTING and previously NOT bedwetting is an early sign of diabetes Early signs: • Increased thirst • Frequent urination • Bed wetting • Extreme hunger • Irritability • Unintended weight loss • fatigue/weakness • Blurry vision 78. Graves disease - hyperthyroidism -s/sx: goiter, exophthalmos (bulging of eyes), tachycardia, restlessness, increase appetite, heat intolerance, diaphoresis -children have difficulty concentrating in school and difficulty sleeping Serious crisis: thyroid storm → tachycardia, palpitations, diarrhea, irritability Labs: low TSH high t3/t4 Med: Methimazole and PTU (monitor liver) or radiation with Radioactive iodine Surgery: thyroidectomy but = permanent hypothyroidism 79. Cushing’s disease - excess of glucocorticoids, most commonly caused by excess use Most common cause in children 7y/o is a pituitary tumor that secretes excess ACTH 80. How endocrine disease will look on a growth chart They’ll have markedly different height and weight. (i.e. weight is 40th percentile while height is 85 percentile) 81. know what is true about breastfeeding 82. know what to do with an unrepaired omphalecele (PREVENT INFECTION, PUT SALINE WATER), keep moist, put in bowel bag 83. clinical manifestations for failure to thrive • Persistent failure to eat adequately with no weight gain or with weight loss in a child under 6 y/o that is not associated with other medical conditions or mental disorders • Weight under 5th percentile • Refuse food • Erratic sleep patterns • irritable/difficult to soothe • Developmentally delayed 84. NO MED MATH